Multidisciplinary Approach Best for Managing Chronic Wounds

By CHASE DOYLE

As the treatment of nonhealing wounds continues to evolve, multidisciplinary care is playing an increasingly important role in the management of complicated patients. During the 2021 virtual American College of Surgeons Clinical Congress, Nicolas J. Mouawad, MD, the chief of vascular and endovascular surgery at McLaren Health Care, in Bay City, Mich., discussed the benefits of multidisciplinary wound care and how to incentivize institutional collaboration.

“Patients with difficult wounds who would often be considered for amputation with a single-specialty approach can now be managed successfully with a multidisciplinary wound team,” he said.

As Dr. Mouawad explained, chronic wounds are generally wounds that fail to heal through the body’s natural healing process (less than approximately 30% closure in four weeks). Whether due to anatomic site, concurrent illness or medical comorbidities, the reasons for lack of healing are often complex, with these wounds posing a significant challenge to both patients and providers.

“Patients with long-term chronic wound abnormalities, particularly those with venous leg ulcers and diabetic ulcers, can suffer for months or even years, and there are significant costs to the healthcare system,” Dr. Mouawad said. “Based on Medicare data, the management of chronic wounds costs between $28.1 billion to $98.6 billion per year.”

The Core Problem

According to Dr. Mouawad, a major problem affecting treatment is that wounds are not considered an actual disease. This misperception leads to a lack of standardization in wound care management, a lack of reproducibility of clinical and research outcomes, an overwhelming array of similar products, and outdated measurement tools for wound evaluation. Moreover, if chronic wounds are to become a disease entity, he noted, there’s the question of who should manage the patient, given multiple stakeholders.

“The management of patients with chronic wounds involves a wide range of specialties,” Dr. Mouawad said. “Taking ownership of the wound requires a multidisciplinary routine approach or a network.”

Multidisciplinary Teamwork

The concept of multidisciplinary teamwork in the management of chronic wounds has been around for decades and is supported by numerous professional associations and organizations. The American Diabetes Association and American College of Foot and Ankle Surgeons, for example, promote a team approach, particularly for diabetic wounds. Importantly, this approach can benefit myriad aspects of healthcare.

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Choosing the Right Dressings For Chronic Wounds

Matthew Murphy, MD, PhD, an assistant professor of plastic and reconstructive surgery at Stanford University School of Medicine, in California, noted that choosing the right dressing for chronic wounds can shorten time to healing, relieve pain and suffering, and reduce the economic burden on both the patient and healthcare system. Dr. Murphy highlighted these three types of dressings that can aid the healing process:

1. Hydrocolloids, an occlusive dressing composed of a hydrocolloid matrix bonded to a vapor-permeable film or foam backing, are known to many wound care physicians, and consist of two main types: hydrocolloid and fibrous hydrocolloid (reserved for moderate to severe wounds). Hydrocolloids absorb exudate, provide thermal insulation, promote a moist wound healing environment, prevent bacterial contamination, reduce friction and shear, and promote epithelial migration.

2. Matrices are tissue-engineered products that act as a tissue scaffold and provide a supporting structure into which cells can migrate. Matrices may be sourced from biologic tissue (animal, human or plants), synthetic materials, and composite materials containing two or more components. “The ideal matrix is one that most closely approximates the structure and function of the native extracellular matrix that it is replacing.”

3. Amniotic products are those obtained from normal amnion/chorionic membrane or umbilical tissue of live newborns. These products undergo proprietary processing for sterility, preservation and retention of growth factors. “Within these dressings, there is a host of regulatory proteins, growth factors, cytokines and chemokines that participate in healing.”